My Radiation/Oncologist Visit

You need to see someone else. I had no RT side effects. I had Space Oars with zero problems afterwards. I m 76.

@stew80 @ecurb

I agree with ecurb I would suggest a second opinion. Are you anywhere close to a major medical facility like Mayo, Cleveland Clinic, John Hopkins, UFHPTI, and many many experienced and outstanding medical facilities.

You can always asked for a second opinion from them. Most of the time you just have your medical records sent to them and they can do a second opinion on diagnosis and treatment options. Sometimes they want additional test done.

Age these days means a number. People live a lot longer than in past. Prostate cancer has gone through some many advancements in both diagnosis and treatments that it has become a specialty with many new and improved treatments.

Did this provider give information on Decipher tests, PSMA, etc. They really help define the risk level of your cancer and whether evidence of spreading.

The Space/Oar or gel is a widely used option. It pushes the colon away from prostate. That helps reduce radiation on the colon. Did you doctor talk to you about difference in photo and proton radiation. With proton radiation the Space/Oar can be real plus.

I had 30 rounds of proton radiation with minimal side affects. I would think hormone treatments would come with much more severe side affects that you will have from radiation.

Definitely get another opinion. I had radiation and ADT and, of the two, radiation was much easier. I'm 20 years younger than you but not sure if that makes a difference in terms of side effects.

With more and more men getting PSA routinely tested these days, the queue sometimes gets busy for specialized follow-ups.

As you can see from their response to you, at 84y, they’re balking at aggressive treatment and leaning towards “Watchful Waiting”: https://www.hopkinsmedicine.org/health/conditions-and-diseases/prostate-cancer/watchful-waiting-for-prostate-cancer

Staying on Eligard means having to live with some undesirable quality of life side effects. And if on ADT for too long, brings risk of the cancer finding an alternative food source - (Cancer cells may develop alternative pathways for growth and survival that are not dependent on testosterone.)

Yes, if applied inaccurately, radiation treatment can have nasty side-effects. When applied accurately, radiation treatment can be quite benign.

Typically, the different number of sessions have different doses of radiation, For instance, I had the choice of (1) 39 sessions at 2.0 Grays of radiation per session, or (2) 28 sessions at 2.5 Grays of radiation per session, or (3) 20 sessions at 3.0 Grays per session, totaling 78 Grays, 70 Grays, or 60 Grays of radiation, respectively. With any of those they can cover the same territory of the prostate as well as the margins, but doing it at higher or lower radiation levels,

Also, remember that EBRT (external beam radiation therapy) is simply a general term that could refer to photon radiation or proton radiation. Which one are they referring to for you?

My radiation oncologist had never used SpaceOAR Hydrogel, but I insisted.,,,so we did. It took us a while to find a local urologist experienced injecting SpaceOAR, and by the time we did, we found that there was a newer improved type of SpaceOAR called SpaceOAR Vue. So, we had to wait just a little while longer to get that in, but we did, got it injected, and that was that.

There are various options for rectal spacers these days: SpaceOAR, Barrigel, BioProtect, or endorectal balloons. (When done right, they work.)

No reason to feel hopeless. You’ll need to get up to speed on all this, get informed, self-advocate, and get whatever treatment you think is best for you,

Good luck!

I think SE’s from ADT are worse than from radiation. Also, don’t fret about Spacer. You could have cancer cells near the rectum and a barrier would prevent their getting treated.
IMRT is pretty sophisticated and they can avoid damage to sensitive structures for the most part. Best,
Phil

Very difficult to have a disappointing consult.

Agree w/ heavyphil that SEs from ADT can be more difficult than radiation (there are radiation SEs, but they usually evaporate after radiation treatment ends).

Lay person out on a limb here:

Radiation is what kills PCa. ADT weakens it's resistance to radiation. ADT alone is suppressive only (which still is good).

ADT only is a choice.

You sound inclined toward more rather than less treatment.

Recent PCF.org patient webinar discussed making ADT decisions on group stage.

Thinking out loud: If I could have radiation as a primary treatment and a short course of 4 - 6 mos ADT, that might be a combination that would be attractive to me versus lifetime ADT only.

I had RP at 72 and salvage radiation treatment with short term 4 mos ADT at 73.

Best wishes.

Thanks to everyone who responded on this particular thread. My forum buds came through and all the medical appointment noise that had troubled me is tempered by reading support and the personal experiences and opinions from you guys. It eases my worry and pumps up my hope.
I realize that the medical folks are busy and really just want to pitch the treatment flowchart with stats and facts. This forum reveals the depth of opinions, experiences, and compassion that is mostly absent from a 15/30 minute oncologist visit. I am so thankful for that.